Treatment indications for antidepressants prescribed to pregnant women: A population‐based descriptive study from Denmark

Abstract

Purpose Antidepressants are the mainstay of pharmacological treatment for nonpsychotic mental disorders in the perinatal period. However, little is known about the indications for antidepressant use during pregnancy. We aimed to examine the treatment indications of antidepressant prescriptions redeemed by pregnant women and to investigate whether treatment indication patterns changed over time. Methods We conducted a population‐based descriptive study using Danish national registers. We identified pregnancies resulting in live births between 2006 and 2016 from the Medical Birth Registry. We linked them to the National Prescription Registry to extract information on antidepressant prescriptions during pregnancy. We used generalized estimating equations to examine whether the indication patterns of antidepressants changed over time. Results A total of 47 093 antidepressant prescriptions associated with 17 170 pregnancies were identified. Overall, 82.3% of pregnancies received antidepressant prescriptions for depression, including 9.2% of pregnancies affected by comorbid indications, mainly anxiety disorders. In addition, 11.5% of pregnancies received prescribed antidepressants for anxiety disorders only, 3.8% for insomnia only, 0.5% for anxiety and insomnia, and 1.9% for other disorders. There was a small decrease in the percentage of antidepressant prescriptions for depression from 2006 to 2016, with an adjusted 1‐year risk difference of −0.4% (95% confidence interval [CI], −0.7% to −0.1%), while the percentage for anxiety disorders increased, and the adjusted 1‐year risk difference was 0.9% (95% CI, 0.7% to 1.1%). Conclusion The majority of antidepressant prescriptions in pregnancy are for depression treatment, which suggests that antidepressant prescription during pregnancy may be a suitable proxy for a depression diagnosis.

Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

“…However, our study population included only pregnancies within women having received a clinical diagnosis for depression and/or anxiety and the majority of antidepressant prescriptions have depression and/or anxiety as an indication. 8 Third, we used consultation rate with psychiatric specialists as a proxy for non-pharmacological care which might have resulted in overestimation of the non-pharmacological care in pregnant women. However, specialists issued only 10% of antidepressant prescriptions while the number of consultations for depression/anxiety are similar to those of GPs.…”

“…Table1. Characteristics of pregnancies included in the study population, Norway, 2009-2018 (8,460 pregnancies) Abbreviations: coef -coefficient, CI -confidence interval. Significant estimates are indicated in bold.…”

“…5 One to five percent of women in Europe fill antidepressant prescriptions during pregnancy, mainly selective serotonin reuptake inhibitors (SSRIs), with depression and anxiety being the predominant indications for use. [6][7][8] Antidepressant treatment discontinuation is highly prevalent (approximately 50%) in pregnant women, especially before the time of conception. [9][10][11][12][13] The discontinuation of antidepressant medications in pregnant women with major depression is associated with risk of relapse and postpartum depression for the mothers and several adverse consequences for the developing neonates.…”

Trajectories of antidepressant drugs during pregnancy: A cohort study from a community‐based sample

“…[26][27][28][29][30] A recent population-based study from Denmark, observed that the prescription of antidepressants was less common during pregnancy than before and after it in the period 1997 to 2016. 31 To our knowledge, only few previous studies have investigated trajectories of medication use during pregnancy. Hurault et al were the first researchers to study psychotropic drugs during pregnancy with longitudinal methods 23 and to describe use of anxiolytics.…”

“…Many studies have shown that the use of antidepressants decreases during the first 3 months of pregnancy 26–30 . A recent population‐based study from Denmark, observed that the prescription of antidepressants was less common during pregnancy than before and after it in the period 1997 to 2016 31 . To our knowledge, only few previous studies have investigated trajectories of medication use during pregnancy.…”